People always ask me if I can double book and/or overlap Medicare patients receiving outpatient therapy services. I’m going to answer this question once and for all and the answer will not only apply to outpatient therapy services paid under Medicare Part B benefits, but will also apply to commercial and workers compensation carriers.
What we need to remember is no insurance carrier cares or dictates how you schedule their patient’s for outpatient therapy services and this also includes the Medicare program. What insurance carriers, including the Medicare program, do care about is that their patient’s receive quality and medically necessary therapy services and those services are billed correctly based on the description of each CPT code and the amount of time spent with the patient.
The biggest mistake I find that providers make is that they do not realize the description of the CPT codes that state “requires direct (one-on-one) patient contact” applies to all patient’s and all insurance carriers, not just the Medicare program. So if a CPT code states “requires direct (one-on-one) patient contact”, the therapist or assistant must be one-on-one with that patient in order to bill that CPT code to the insurance carrier.
So lets answer the question “Can I double book Medicare patient’s”? The answer is
The content here is for members only log in here or sign up.
All material posted on our website is the intellectual property of Gawenda Seminars & Consulting, Inc. and can’t be used, reproduced, or posted as your own material without the prior written approval of Gawenda Seminars & Consulting, Inc.
This article is not intended to and does not serve as legal advice or as consultative services, but is for general information purposes only.
I have shared this article with my team and have received a lot of comments. You spoke to us several years ago at our facility and stated that if you have a tech as an extender you can bill commercial. Have the rules changed?
Whether you are allowed to use support personnel to provide therapy services under the supervision of a therapist would depend on the insurance carrier as well as your state practice act. If either one says no, then the answer is no. Both must allow it.
Does Medicare allow for an extender to be used? I have always been taught no.
The answer to your question can be found in this article that I wrote in March 2016.
Can at PT and OT overlap treatment times/ co-treat and each bill for their time?
If PT is working to assist patient and/or provide challenges with standing balance while OT is working on ADLs at the sink is this not billable by both clinicians?
PT and OT can’t bill for the same time period. For example, if the patient only received 30 minutes of time-based therapy interventions (i.e. 97530), they can only be billed 2 units of that CPT code.